Claims Process PPO Plus
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
Health Net is responsible for processing all claims under the Salud con Health Net PPO Plus plan as follows:
- Health Net PPO providers in California send their claims directly to Health Net PPO claims
- Out-of-network providers in California send their claims to Health Net
- Sistemas medicos Nacionales S.A. de C.V (SIMNSA) providers send their claims to SIMNSA, which forwards the claims to Health Net
- Out-of-network providers in Mexico send their claims to SIMNSA, which generates any needed denial letters and forwards applicable claims to Health Net for payment